Missing EU already?Of course, the major issue dominating policy in the UK this year has been Brexit. In July, we reviewed a new book by Professor Janet Morphet which assessed the UK’s future outside the European Union. While not claiming to have all the answers, the book provides a framework for making sure the right questions are asked during the negotiation period and beyond.

One important consideration concerning Brexit is its potential impact on science, technology and innovation. In August, we noted that, while the UK government has been making efforts to lessen the concerns of researchers, anxieties remain about funding and the status of EU nationals currently working in science and technology roles in the UK.

Home thoughts, from home and abroadThroughout the year, we’ve been looking at the UK’s chronic housing crisis. In May, we considered the potential for prefabricated housing to address housing shortages, while in August, we looked at the barriers facing older people looking to downsize from larger homes. In October, we reported on the growing interest in co-housing.

The severe shortage of affordable housing has had a significant impact on homelessness, and not only in the UK. In April, we highlighted a report which documented significant rises in the numbers of homeless people across Europe, including a 50% increase in homelessness in France, and a 75% increase in youth homelessness in Copenhagen.

One European country bucking this trend is Finland, and in July our blog looked at the country’s success in reducing long term homelessness and improving prevention services. Although the costs of Finland’s “housing first” approach are considerable, the results suggest that it’s paying off: the first seven years of the policy saw a 35% fall in long term homelessness.

Keeping mental health in mindA speech by the prime minister on mental health at the start of the year reflected growing concerns about how we deal with mental illness and its impacts. Our first blog post of 2017 looked at efforts to support people experiencing mental health problems at work. As well as highlighting that stress is one of the biggest causes of long-term absence in the workplace, the article provided examples of innovative approaches to mental illness by the construction and social work sectors.

A further post, in August pointed to the importance of joining up housing and mental health services, while in September we explored concerns that mobile phone use may have negative effects on the mental health of young people.

Going digitalAnother recurring theme in 2017 was the onward march of digital technologies. In June, we explored the reasons why the London Borough of Croydon was named Digital Council of the Year. New online services have generated very clear benefits: in-person visits to the council have been reduced by 30% each year, reducing staffing costs and increasing customer satisfaction from 57% to 98%.

Also in June, we reported on guidance published by the Royal Town Planning Institute on how planners can create an attractive environment for digital tech firms. Among its recommendations: planners should monitor the local economy to get a sense of what local growth industries are, and local authorities should employ someone to engage with local tech firms to find out how planning could help to better facilitate their growth.

Back to the future2018 is already shaping up as an important year in policy and practice. One important issue exercising both the public and private sectors is preparing for the General Data Protection Regulation. The Knowledge Exchange blog will be keeping an eye on this and many other issues, and the Idox Information Service, will be on hand to ensure our members are kept informed throughout 2018 and beyond.

Thank you for reading our blog posts in 2017, and we wish all of our readers a very Happy Christmas and a peaceful and prosperous New Year.

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In less than two months time the UK will come together to recognise the 700,000 young people in the UK who provide care and support to families and friends, on Young Carers Awareness Day on 25 January.

Every day, children and young people provide physical and emotional care and support to their family members. Helping with household tasks, they care for young siblings, administer medication and deal with the emotional and physical stress of caring for a loved one with an illness. Estimates of the number of young carers living in the UK vary greatly. But Carers Trust suggests the number of young carers to be around 700,000 – that’s 1 in 12 secondary school-aged pupils. And those are only the ones we know about. Too many are falling through the net, going unnoticed and unidentified by services who can support them.

Attainment and employment

Earlier this year we joined in publicising the 2017 Young Carers Awareness Day, whose theme was “When I grow up”. The idea was to help people to understand how difficult it can be for young carers to realise their hopes and dreams for the future without the right support in place. A survey conducted by the Young Carers Trust found that over half (53%) of those surveyed were having problems in coping with schoolwork, with nearly 60% struggling to meet deadlines. Over 70% have had to take time out of school or learning specifically to care for a family member. A third admitted that they have to skip school most weeks.

With over 50% of young carers surveyed by The Children’s Society admitting that their caring responsibilities have caused them to miss days at school, and the burden of caring impacting on the ability of children to engage fully with school activities, it is unsurprising that young carers are twice as likely to be NEET as their peers. In addition, young carers in work find caring responsibilities have a disruptive effect on their workplace attendance, with understanding and flexible employers often being the difference between young adult carers remaining in work or becoming unemployed.

Mental health and wellbeing

Caring for a relative takes a massive toll on a young person. Recent reports published by Carers Trust and the Children & Young People’s Commissioner Scotland (CYPS) both show the significant mental health burden that caring places on a young person. Stress, isolation and anxiety that can come as a result of being a carer can have a significant impact on a child as they lose much of their contact with the outside world, become removed from social groups and miss out on opportunities to experience a “normal” childhood. Projects like Off the Record’s Young Carers Project in Croydon provide support and opportunities for respite for young carers. But it is clear that as child and adolescent mental health services (CAMHS) are becoming increasingly stretched themselves, it is more important than ever to ensure that specialist services are also made available to young carers.

Partnerships working to provide support

Young carers often come into contact with multiple services. Education, social care, health and others all have an impact on young carers and their experiences and as a result can have a positive impact on their experiences too. Increasingly, services are being encouraged to cooperate in order to create a holistic support network for young carers, which encompasses every area of need they may have, and creates a seamless transition for young carers through all of their interactions with various services. Key coordinators and facilitators are vital in this role.

In the previously referenced report from CYPS, it was highlighted that many young carers felt positive about – and took pride in – their caring role, but that around two-thirds also said they felt “left out of things” at least some of the time. While they care for their loved ones, we need to make sure someone is caring for them.

Last week saw the launch of Universities UK’s #stepchange campaign – a framework that aims to help universities support the mental wellbeing of their student populations. In their case for action as to why the framework was needed, the organisation noted that recent years have seen an increase in the number of student suicides in the UK and the US, as well as an increase in the number of students reporting mental health issues.

Both countries rank in the top 10 in terms of smartphone users across the world, with close to 70% of each country’s population being smartphone owners. And within that percentage, 18-24 year olds are the highest using age group.

Smartphone dependence and its impact

Earlier this year, the Royal Society for Public Health (RSPH) released a report that looked at the impact that the ubiquity of smartphones is having on young people’s mental health, focusing on their social media activity. Some of the headline figures from the report include the fact that over 90% of the 16-24 age group use the internet for social media, primarily via their phones. It is also noted that the number of people with at least one social media profile increased from 22% to 89% between 2007 and 2016. Also on the increase? The number of people experiencing mental health issues including anxiety and depression.

Can rising anxiety and depression rates really be linked to increased internet and smartphone use? The RSPH report notes that social media use has been linked to both, alongside having a detrimental impact on sleeping patterns, due to the blue light emitted by smartphones. This point came from a study carried out at Harvard, which looked at the impact of artificial lighting on circadian rhythms. While the study focused on the link between exposure to light at night and conditions including diabetes, it also noted an impact on sleep duration and melatonin secretion – both of which are linked to inducing depressive symptoms.

So what’s the answer? Smartphones aren’t going away anytime soon, as seen in the excitement that greets every new edition of the iPhone, a decade on from its launch. With children now being as young as 10 when they receive their first smartphone, parents obviously have a role in moderating use. This inevitably becomes more difficult as children grow up, however, and factors such as peer pressure come into play. And it’s also worth acknowledging that heavy smartphone use isn’t restricted to the younger generation – their parents are just as addicted as they are.

Supporting children and young people

In February Childline released figures which stated that they carried out over 92,000 counselling sessions with children and young people about their mental health and wellbeing in 2015-16 – equivalent to one every 11 minutes. Although technology clearly has its impact – the helpline has also reported a significant increase in the number of sessions it carries out in relation to cyberbullying – the blame can’t be laid completely at its door. Although the world has gone through turbulent times in the past, it’s been well documented recently that today’s young people have it worse than their parents’ generation, particularly in terms of home ownership and job stability. Others have pointed towards a loss of community connections in society, and children spending less time outdoors than previous generations – not only due to devices that keep them indoors but also hypervigilant parents.

In fact, perhaps we hear more about mental health issues experienced by children and young people because smartphones and social media have given them an outlet to express their feelings – something previous generations didn’t have the ability to do. What we should be focusing on is how to respond to these expressions – something we’re still not getting right, despite countless reports and articles making recommendations to governments on how they can do better in this area.

Follow us on Twitterto see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other articles on mental health.

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing – stable, safe housing – also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.

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In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

“A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention based in part on the Detroit model.

The evaluation found there were a range of activities that had taken suicide prevention activities out into local communities. They included:

training key public service staff such as GPs, police officers, teachers and housing officers

training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers

creating ‘community champions’ to put local people in control of activities relating to promoting positive mental health and signposting to help services

putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways

working with local newspapers, radio and social media to raise awareness in the wider community

supporting safety planning for people at risk of suicide, involving families and carers throughout the process

linking with local crisis services to ensure people get speedy access to evidence-based treatments.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.

The first journey into work after the Christmas break has to be one of the most painful journeys of the year. Overfed, possibly hungover, still angry at that sly comment your distant relative made across the dinner table a week ago, you and many others return to work at the start of January with the glow of the next set of bank holidays seeming very far in the distance (FYI the next bank holiday is Good Friday on 14th April – yes, APRIL *sobs*).

It’s no surprise then, that January is the time of the year that sees the highest rates of divorce. This is the month heralding some of the highest stress rates of the year, and is the lowest point in the calendar for many people who face daily battles with mental health. A researcher at Cardiff University, Dr Cliff Arnall has even created a formula to work out that 24th January is the “most depressing day of the year”.

Mental health takes centre stage at work

It’s therefore apt that as many of us spend much of our time at work, there has been an increasing recognition of the role of employers in supporting mental health.

In October 2016, Business in the Community published its 2016 Mental Health at Work report, which included a toolkit for employers. The report highlights the damage that concealing their condition can do to people with mental health problems, as well as the level of support that should be made available to employees to help promote positive mental health and wellbeing in the workplace.

Recommendations made in the report include:

Talk – Organisations and employers should break the culture of silence that surrounds mental health, particularly in the workplace by talking the Time to change employers pledge

Train – Organisations and employers should invest in training to ensure basic mental health literacy for all employees in all areas of the business

Take action – Organisations and employers should “close the gap” by asking all staff about their experiences of their own mental health at work and how any issues have been dealt with. Understanding the perceptions that staff have of how the company supports mental health generally across the organisation, can help identify steps to improve/ change practice if necessary.

Employers role in removing stigma

Ensuring good mental health in the workplace affects all levels of staff, from senior management to the newest members of staff who are still training or serving a probationary period. Multiple reports, including those by ACAS, CIPD, MIND and The Work Foundation, have stressed the importance of employers setting an example to their staff. That includes senior staff recognising when they need to take time to support their mental wellbeing too.

40% of respondents said that stress-related absence increased over the past year for the workforce as a whole

20% said it increased for managers

1 in 8 reported a rise for senior managers

Only 44% would feel confident enough to disclose unmanageable stress or mental health problems to their current employer or manager.

The report suggested that if senior managers acknowledged their own mental health issues, it would remove some of the stigma associated with asking for help with mental health in the workplace. However, doing this requires a significant culture shift in how many organisations are run – which could take years. The Work Foundation, commenting on the 2016 version of the CIPD report, found that:

“Effective management of mental health in the workplace can save around 30% of costs felt by employers. Line managers have a really important role to play in creating an environment where employees feel safe to disclose with the knowledge that the organisation will do something to help them. Managers need to have a positive employment relationship where open and honest conversations can be had to discuss any required adjustments and provide that supportive environment.”

Using “blue Monday” to initiate conversations on mental health

This year “Blue Monday” falls on the 16th January. It may be called the worst Monday of the year, but employers are being encouraged to use the publicity around it to create opportunities for employees to discuss mental health in the workplace.

Questions to ask could be: what makes them stressed, what makes them anxious, how can the office environment be changed to improve the wellbeing of employees? There are also ideas for activities to help staff “beat the blues”, including lunchtime exercise, healthy eating and talking to colleagues about things other than work.

Specific sectors have also begun to initiate schemes to try to improve mental health and well being. Mates in Mind is a programme to be launched in early 2017 by the Health in Construction Leadership Group with the support of the British Safety Council. Modelled on an Australian programme, it is a sector-wide programme intended to help improve and promote positive mental health across the construction industry in the UK.

In social work, too, informal peer mentoring schemes have sprung up organically in many offices, with co-workers giving each other support when they need it, often in an informal capacity. More formal schemes have been set up to help social workers monitor and feel safe when talking about their mental health to colleagues and superiors. Feedback indicates that the low rate of retention of social workers is, in part, due to stress caused by secondary trauma or excessive caseloads.

So, as we trudge back to our desks for the first working days after Christmas, it is perhaps worth keeping some of these ideas in mind. Employers are keen to talk about mental health, but they also need the input of staff in order for them to work.

Putting some of these ideas into practice, may also go some way to improving the situation of many with hidden mental health conditions in the workplace who don’t feel confident enough to speak openly about it. We needn’t wait for the next bank holiday to improve our mood, small changes can make a big difference to wellbeing in the workplace!

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In the UK, increased life expectancy means that people can expect to live longer than ever before. While this is clearly good news – and has a number of potential economic benefits – the shift in demographic structure towards an increasingly elderly population has a number of significant implications.

Following Wednesday’s blog post on the implications for planning of the ageing society, today we highlight some of the ways in which planners can help support the creation of age-friendly environments by influencing the design of the urban environment, transport, housing and the wider community and neighbourhood.

The importance of an age-friendly environment

Age-friendly environments are underpinned by three key factors:

Safety

Accessibility

Mobility

Such environments impact positively upon the quality of life of older people by enabling and encouraging physical activity and social connection. This in turn has a beneficial impact upon their physical and mental health, and helps to tackle social exclusion – which can be a particular problem among older people.

“older people who live in an unsafe environment or areas with multiple physical barriers are less likely to get out and therefore more prone to isolation, depression, reduced fitness and increased mobility problems”

Creating an age-friendly environment

There are a number of areas in which planners may have an influence on the provision of age friendly environments:

the design of the urban environment

supporting appropriate transport options

the provision of age-appropriate housing

adequate neighbourhood and community facilities

Urban environment

In terms of the urban environment, green spaces are an integral aspect of age friendly environments. Access to green spaces supports the physical activity of older people, makes a positive contribution to their health and wellbeing, and provides opportunities for social interaction.

Research has found that green spaces that are poorly maintained, perceived as unsafe, or contain potential hazards resulting from the shared use of parks and walkways are less likely to be used by older people. Suggestions for improvement include the creation of small, quieter, contained green spaces and improved park maintenance.

Paths, streets and pedestrian areas are also a key planning consideration. Older people have greater reliance on pedestrian travel and are more likely to be physically active in areas that are pedestrian friendly. The perception of safety also influences use – therefore, lighting and road safety measures can help to enhance this.

Adequate public toilet provision will also become an increasingly important issue. Recent cutbacks have resulted in many public toilets being closed – in their review of public toilet provision in the UK Help the Aged noted that provision was sporadic. They found that the majority of older people had experienced difficulties in finding a public toilet, and even when toilets were found, they were often closed.

Transport needs

Responding to the transport needs of different groups will also present a key challenge. For example, an analysis of major European cities by the Arup engineering consultancy found that older people typically make fewer journeys, use private cars less, public transport more (trams and buses in particular) and walk more. In addition to this, older people’s typical walking speed – as well as the average length of walking trips – were lower than younger people’s patterns. These differences must be considered when designing age-friendly environments.

The growing population of older people in rural and semi-rural areas, and the reliance on cars in areas with limited public transport options were also identified by Arup as important issues.

Age-appropriate housing

There will be increased demand for age-appropriate housing that meets the needs of older people as the population ages. People are likely to have longer periods of retirement and possibly longer periods of ill-health. As noted by the Future of an Ageing Population Project, unsuitable housing can damage individual wellbeing and increase costs for the NHS.

In order to meet demand, it will be necessary to both adapt existing housing stock, as well as ensure that new housing can adapt to people’s changing needs as they age. Age-appropriate housing that supports independent living can reduce demand on health and care services, and positively enhance the lives of older people.

Thinking ‘beyond the building’

There is also a need to think ‘beyond the building’. It is thought that interventions that improve homes are likely to be less effective without similar improvements in the neighbourhood. The ability to socialise and to access services is considered to be particularly important.

Therefore, planning for the provision of local shops and other community facilities such as GP surgeries, post offices and libraries, in tandem with an increased focus on walkable neighbourhoods and public transport provision, will help older people to be physically active and more independent.

Raising awareness

Despite a pressing need for action, the provision of age friendly infrastructure in the UK has been constrained by a lack of resources, and assigned a relatively low priority. However, there is growing recognition of the need to raise awareness of the potential effects of the ageing population and its implications for the design of cities, towns and villages across the UK.

Planning departments cannot address these implications in isolation. However, for their part, knowing and understanding the potential implications of the UK’s ageing population is a positive step towards the creation of a successful age-friendly built environment.

On average, the UK’s population is becoming older and living longer, healthier lives. This is due to historically low fertility rates and reduced mortality rates. Between 2014 and 2039, the government predicts that over 70% of UK population growth will be in the over 60 age group. Although this trend is partially countered by migration, by 2037 there will be 1.42 million more households headed by someone aged 85 or over.

The implications of population ageing for society are so complex and far reaching that they are impossible to fully predict. However, a key priority is the provision of age-friendly environments. This is where local government, and planning departments in particular, have a crucial role to play.

In this blog post – the first of two on the implications of population ageing for planning – we highlight some key areas for consideration.

Some areas will be more affected than others

While headline-grabbing statistics paint a very clear picture of the significant growth in the number of older people that is predicted, often they obscure the subtleties of the way in which population ageing will occur across the UK.

In reality, it is likely that population ageing will not occur equally in all areas of the UK. The degree to which some local authorities – and therefore planning departments – will be affected varies considerably.

The impact of population ageing is measured by a ‘dependency ratio’ – the number of people aged over 65 for every person between 16 and 64.

Recent research has found that coastal localities are likely to have higher dependency ratios than urban areas. Urban areas will, however, experience a larger overall number of older people.

Dependency ratios will vary considerably between local authorities. On average, it is predicted that by 2036, there will be over four people aged over 65 for every 10 people aged between 16-64. However, local figures are likely to vary – from just over 1 in 10 in Tower Hamlets, up to 8 in 10 in West Somerset.

And while there is awareness of the growth in the overall numbers of ‘older people’, another complexity is that ‘older people’ are not a homogenous group.

As life expectancy increases, the differences between different age groups become more significant. For example, there are variations in the needs, tastes and lifestyles between the ‘older old’, i.e. those aged over 80, and the ‘young old’ who are just approaching retirement age.

Some planning departments are already taking this into consideration. Northumberland County Council – who have a higher than average number of older people within their population – use a three phase definition as part of their strategy to prepare for the ageing population. They categorise ‘older people’ into three distinct groups: older workers; ‘third agers’; and older people in need of care.

Understanding social impact and interpretation

The physical environment is commonly understood to be a ‘societal context’ in which ageing occurs. This is reflected in the term ‘physical-social environment’ – it suggests that there is no physical environment without social interpretation.

However, recent research has found that while planners were reasonably aware of the physical needs of older people, they were less aware of the social and economic contexts of older people’s lives. This included the links between wellbeing and attractive environments, green space, activity and health, and the positive impact of place attractiveness on social interaction.

Related to this, older people’s social interpretation of the built environment – including the importance of place meanings, memories and attachments ­– is likely to become an increasingly important consideration for planners. As too is the potential effect of redevelopment on older people – which may include feelings of insecurity and alienation, disorientation, loss of independence, and social exclusion.

Involving older people in the planning system

How to effectively involve older people in the planning system in an increasingly technology-dependent age will pose a number of challenges.

Planners will need to think creatively about options for engagement. Increasingly, social media platforms and other online media have been used to engage with users. However, these technologies may not be readily accessible or easily used by older people due to a lack of technological skills or access to the internet.

Older people may also need certain adaptations to support them to become involved – either online or in person – if they have physical or other disabilities.

Negative assumptions about technology’s usefulness held by some older people may need to be challenged or worked around.

Supporting healthy and happy lives

There is no way to fully predict the impact that population ageing will have across all sections of society. Developing our understanding of the way in which the built environment can help to support and enable older people to live happy and healthy lives – and the implications of this for planning towns and cities across the UK – is increasingly important.

In our next blog post we will look at some of the ways in which planners can help support the creation of age-friendly environments through their influence on the design of the urban environment, transport, housing and the wider community and neighbourhood.

Ian Jackson of the Bromley by Bow Health Partnership was the guest speaker at the first Glasgow Centre for Population Health (GCPH) seminar series of the year.

The Bromley by Bow Health Partnership (BBBHP) is a collaboration between three health centres and other non-primary care partners in the Tower Hamlets area of London. The aim of the partnership – and the new primary care delivery model which comes with it – is to transform the relationship between the public and primary health care. This means considering the wider determinants of health when the partners plan and deliver care, rather than treating healthcare in a purely biomedical way.

In the 1890s Charles Booth created a map of London which categorized areas of the city of London depending on their levels of deprivation. The most recent Indices of Multiple Deprivation Report showed that those same areas considered deprived in the1890s are still facing the highest levels of multiple social deprivation and health inequality today. It is no secret that disadvantage has a negative impact on people’s ability to make the best choices when it comes to health. And disadvantage at a social level can have a significant influence on poor physical and mental health across a range of conditions.

He produced what is known as the 30/70 model: 30% of what determines your health is your genetics and improvements in pharmacology, the other 70% is related to other “external factors” including poverty, environment, culture, employment and housing. BBBHP has used this as the foundation for their primary care model, arguing that primary care providers are not just dispensers of medical products, but have a responsibility to contribute to people living healthier lives in their community.

Social prescribing

One issue highlighted by the BBBHP was the significant number of people presenting at GP surgeries with “non-medical” ailments, or medical ailments triggered by “non-medical stimulus”. People were arriving at the practices and booking appointments because they were lonely and it gave them somewhere to go. Others were presenting with symptoms of depression, which on further investigation were found to have stemmed from issues around debt or domestic violence. A social prescribing service was set up by the partnership to try to tackle some of these non-medical conditions and improve the health of the general population by non-pharmacological means.

The social prescribing service, where GPs refer people to other local services for help, can be used as a replacement for pharmaceutical interventions, or be supplementary to them. GPs, or other primary care staff, may refer any adults over the age of 18 to one of over 40 partnership organisations. These range from walking groups to formal sessions with advisors in debt or domestic violence agencies, as well as art classes, community gardens and companionship services to combat loneliness. The organisations can provide help and advice on issues such as employment and training, emotional well being and mental health.

The challenges of quality and funding

Maintaining quality in the provision of social prescribing is a particular challenge for BBBHP. They work regularly with trusted partners, particularly the Bromley by Bow Centre. However, there is no consistent quality check for many of the services from the health partners themselves. Evaluative studies and feedback sessions are used to assess quality and impact, and consider the scale of demand. And while it is acknowledged that more formal frameworks for assessing quality and impact of social prescribing services are preferred in formal assessments, in reality, word of mouth, participant feedback and uptake rates are used as a standard for quality as much as official feedback in a localised community setting.

A second issue is funding. BBBHP identified that finding long term funding was their main issue in providing security for providers and service users, as well as for GPs referring to services. Funding is vital not only to ensure the survival of the community groups who provide some of the referred services, but also to allow them to develop longer term partnerships and build capacity within the social prescribing service. The BBBHP works closely with the Bromley by Bow Centre, a key provider of support services for the local community, but like many services which rely on funding, they increasingly have to plan for tighter budgets.

A final challenge for the staff at BBBHP was changing people’s expectations of primary care, and what it means to live well. Some patients were suspicious and reluctant to be recipients of “social prescription”, as this did not fit with the traditional expectation of what GPs should do to make people well. This can be a big change in mindset for some people, according to Ian Jackson, when people come expecting to be prescribed antidepressants but are instead “prescribed” a walking club or a debt advice service. He noted that the reaction from patients can sometimes be confused or hostile, and some patients do not even turn up for referrals.

Improving patients’ understanding of the benefits of social prescription, ensuring people attend referral appointments, and that social prescriptions have a long term impact is something which BBBHP are hoping to research further. They feel that looking at the long term impact of non-pharmaceutical interventions and how these feed back into the wider agenda of tackling inequalities is important to allow the partnership to continue to build healthy communities and save on primary care costs in the long term.

Creating positive social connections to improve community health

Social prescribing and other associated projects have sparked new social connections. Members of the community have come together to form their own support groups. The Children’s Eczema support group run by local GPs and the DIY health scheme, which sought to educate and support parents who were anxious about minor ailments in children, have helped parents in the area to set up WhatsApp groups, organise coffee mornings and go to one another for support. Such initiatives are regarded by BBBHP as important in tackling wider, systemic social inequality in the area.

Currently, primary health care in communities is focused on illness. This needs to change, according to BBBHP, with local community-based health delivery based as much around social health as biomedical issues. Through its social prescribing and other services BBBHP has aimed to focus on supporting people in a holistic way, tackling health inequalities as well as biomedical illness, to allow them to make good choices to improve their health.

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